Anesth Pain Med.  2017 Jan;12(1):42-46. 10.17085/apm.2017.12.1.42.

A case involving anesthesia for cesarean section followed by resection of ruptured cavernous malformation of pons :A case report

• Park SK
• Kang JG
• Wie HW
• Shin EY

• KMID: 2369665
• DOI: http://doi.org/10.17085/apm.2017.12.1.42

Abstract

Cavernous malformation is an important cause of cerebral hemorrhage in pregnant women. We experienced a case of cesarean section followed by neurosurgery for resection of ruptured cavernous malformation of pons in a 24-year-old pregnant woman. Establishing integrated treatment strategy for pregnant women with cavernous malformation is difficult because of the small number of cases. Therefore, the cooperation between the brain surgeon, anesthesiologist and obstetrician is essential when surgical intervention is needed. Despite aspiration pneumonia, the patient successfully underwent surgery. We reported this case along with a brief literature review.

Keyword

Cavernous hemangioma; Cavernous malformation; Cesarean section; Pregnancy

MeSH Terms

Anesthesia*
Brain
Cerebral Hemorrhage
Cesarean Section*
Female
Hemangioma, Cavernous
Humans
Neurosurgery
Pneumonia, Aspiration
Pons*
Pregnancy
Pregnant Women
Young Adult

Figure

• 

  Fig. 1 Brain magnetic resonance imaging before surgery shows about 2.1 cm hemorrhagic mass in the pons.

• 

  Fig. 2 Chest radiograph after surgery shows diffuse increased opacity in left lung.

Reference

1. Robinson JR, Awad IA, Little JR. Natural history of the cavernous angioma. J Neurosurg. 1991; 75:709–14. DOI: 10.3171/jns.1991.75.5.0709. PMID: 1919692.

2. Kivelev J, Niemelä M, Hernesniemi J. Characteristics of cavernomas of the brain and spine. J Clin Neurosci. 2012; 19:643–8. DOI: 10.1016/j.jocn.2011.08.015. PMID: 22502911.

3. Abla AA, Lekovic GP, Turner JD, de Oliveira JG, Porter R, Spetzler RF. Advances in the treatment and outcome of brainstem cavernous malformation surgery: a single-center case series of 300 surgically treated patients. Neurosurgery. 2011; 68:403–14. DOI: 10.1227/NEU.0b013e3181ff9cde. PMID: 21654575.

4. Safavi-Abbasi S, Feiz-Erfan I, Spetzler RF, Kim L, Dogan S, Porter RW, et al. Hemorrhage of cavernous malformations during pregnancy and in the peripartum period: causal or coincidence? Case report and review of the literature. Neurosurg Focus. 2006; 21:e12. DOI: 10.3171/foc.2006.21.1.13. PMID: 16859250.

5. Dias MS, Sekhar LN. Intracranial hemorrhage from aneurysms and arteriovenous malformations during pregnancy and the puerperium. Neurosurgery. 1990; 27:855–65. DOI: 10.1227/00006123-199012000-00001.

6. Kiliç T, Pamir MN, Küllü S, Eren F, Ozek MM, Black PM. Expression of structural proteins and angiogenic factors in cerebrovascular anomalies. Neurosurgery. 2000; 46:1179–91. DOI: 10.1097/00006123-200005000-00032. PMID: 10807251.

7. Nagamine N, Shintani N, Furuya A, Suzuki S, Nonaka A, Abe F, et al. Anesthetic managements for emergency cesarean section and craniotomy in patients with intracranial hemorrhage due to ruptured cerebral aneurysm and arteriovenous malformation. Masui. 2007; 56:1081–4. PMID: 17877052.

8. Chotai S, Qi S, Xu S. Prediction of outcomes for brainstem cavernous malformation. Clin Neurol Neurosurg. 2013; 115:2117–23. DOI: 10.1016/j.clineuro.2013.07.033. PMID: 23962756.

9. Hawkins JL. Anesthesia-related maternal mortality. Clin Obstet Gynecol. 2003; 46:679–87. DOI: 10.1097/00003081-200309000-00020. PMID: 12972749.

10. Gin T, O’Meara ME, Kan AF, Leung RK, Tan P, Yau G. Plasma catecholamines and neonatal condition after induction of anaesthesia with propofol or thiopentone at caesarean section. Br J Anaesth. 1993; 70:311–6. DOI: 10.1093/bja/70.3.311. PMID: 8471376.

11. Tran DT, Newton EK, Mount VA, Lee JS, Wells GA, Perry JJ. Rocuronium versus succinylcholine for rapid sequence induction intubation. Cochrane Database Syst Rev. 2015; 10:CD002788. DOI: 10.1002/14651858.cd002788.pub3.

12. Wang LP, Paech MJ. Neuroanesthesia for the pregnant woman. Anesth Analg. 2008; 107:193–200. DOI: 10.1213/ane.0b013e31816c8888. PMID: 18635488.

13. Korula G, Farling P. Anesthetic management for a combined Cesarean section and posterior fossa craniectomy. J Neurosurg Anesthesiol. 1998; 10:30–3. DOI: 10.1097/00008506-199801000-00007. PMID: 9438616.

14. Martinez-Tica J, Vadhera RB. Disorders of the central nervous systemin pregnancy. Obstetics Anesthesia and Uncommon Disorders. 2nd ed. Gambling DR, editor. New York: Cambridge University Press;2008. p. 167–90. DOI: 10.1017/CBO9780511544552.010.

15. Wlody DJ, Weems L. anesthesia for neurosurgery in the pregnant patient. Cottrell and Young’s Neuroanesthesia. 5th ed. Cottrell JE, editor. Philadelphia: Mosby, Inc;2010. p. 416–24.